Clinical Illness

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Secord doorbelled for you during last year's election. He was worried about your opponent, Mark Sidran, lacking compassion and shredding Seattle's social safety net. Now he feels betrayed by your budget choices. He wonders if he backed the right guy.

Secord knows a lot about core human services because he's the executive director of the Puget Sound Neighborhood Health Centers. Mayor, you used to be the go-to guy at the county on public health, so I'm sure you are aware of the unique and wonderful thing we've got going here in King County. There is a network of 28 community clinics in King County that specialize in providing medical care to poor people and the uninsured—some 94,000 people in 2000. It is one of the treasures of our community, built up over the past 30years with help from a variety of people, including every previous mayoral administration dating back to Wes Uhlman. So why are you cutting public health by over 25 percent—more than any other part of your budget?

I know your budget hole is big. Past mayors faced tough times, too, however. Uhlman started helping the community clinics during the real Boeing bust of the early 1970s. Since then, Charles Royer, Norm Rice, and Paul Schell have all managed never to reduce the city's contribution.

It's not only the poor who need Country Doctor, the 45th Street Clinic, the Pike Market Clinic, and all the rest of them. It's also people who simply don't have health insurance. I was one of those people once. After I got out of college, my first job didn't provide coverage. When I got sick, my friends told me about Country Doc, with its sliding scale. I paid around $5 for a visit to a doctor who provided me with excellent care and wasn't freaked out by my crazy lifestyle, unusual diet, or wacky health problems. I took Country Doc for granted because I didn't understand how much hard work went into establishing the community-clinic network. The network has grown and thrived on a partnership among professionals, activists, the feds, the state, the county, and the city. Seattle shouldn't back out now.

THE MOST RECENT estimate shows there are 130,000 uninsured people in our county, and Secord believes the number is rising with all the Boeing layoffs, not to mention the fact that Washington leads the nation in unemployment. Now is not the time to whack the community-clinic budgets. Forty percent of their clients are uninsured. No other health provider in our community sees anywhere near that number.

The kind of medicine that community clinics practice—preventive primary care—is as important as the sheer number of people served. Primary care isn't sexy. It doesn't attract big grants from foundations. But if the uninsured and the poor don't have access to primary care at community clinics, they show up in Harborview Medical Center's emergency room, where care is a lot more expensive. Moreover, preventive care at community clinics is a first line of defense against the spread of infectious disease.

If your cuts go through, the clinics estimate they will provide 15,000 fewer visits for the uninsured next year. More the year after. The bulk of the uninsured are children and people aged 18 to 64. (Medicare provides at least basic coverage for most of the elderly). King County Executive Ron Sims wants to completely eliminate support for the clinics. Everyone agrees cuts will also occur at the state level. There is no bailout coming from the federal government, because our care for the uninsured is relatively better than in other parts of the country.

To make matters worse, you didn't call Mark Secord or other representatives of the clinics into your office to explain what was coming or offer to help them with these cuts. Instead, you wielded "a meat ax and said, 'Here, live with it,'" according to mild-mannered Seattle City Council member Richard Conlin.

I've talked to your representatives, Deputy Mayor Tim Ceis and Dr. Alonzo Plough, director of Public Health- Seattle & King County. Ceis is legally correct when he says, "Public health is not the city's responsibility." Some years ago, the state mandated that counties are in charge of public health. There was never enough money for the uninsured, however. That's why liberal Seattle has been providing money that our more conservative state government will never provide.

PLOUGH SAYS HIS public-health clinics can provide care for the uninsured without subsidy. Secord lauds the work that Plough's clinics do but says there is some funky math going on to reach the "no-subsidy" conclusion. It really gets down to what you count as a subsidy. Secord says Plough excludes government money for immunization, HIV/AIDs, tuberculosis, family planning, and interpreter services from his definitions of primary-care subsidies. Secord knows the figures backward and forward, and he can explain them in plain English. You or your staff need to sit down and go over this stuff with him.

Remember, he and a lot of the rest of us voted for you because we thought you understood the "Seattle way" was about "putting people first."